HomeMy WebLinkAboutWIRE LATH All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: dyq Permit Number:,
RECEIVED
- SEP 192018
Building Permit Application
Planning and Development Services ST. Lucie County, PcrmiGtin9_
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: o C c' � �y W ��� �.�►�'
- PR�PiJSED fNP OVEM NT LCICATCQ'N:
dL
Address: 0
Legal Description:
Property Tax ID#: o'2- 40 n1 D 5_2-�) 000 T Lot No.
Site Plan Name: Block,No.,
Project Name:
Setbacks Front Back: Right Side: Left Side:
ET )SLED DE�5Cft1� TfON �F WOR#
o
CQ: STRUCT'w tN '4 � TION:
Additional work to be performed under this permit-c ec a that appy:
_Mechanical —Gas Tank _Gas.Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ - Utilities: —Sewer —Septic Building Height:
R00 IS
CONTRACTOR:
Name K k Name:
Address: Cocv4Zl ,2 ('� IZ Company:'.
City: w,2 PI�r2� State: Address:
Zip Code: `3��i' �� Fax: City: State:
Phone No. C7 (o S 7 Zip Code: Fax:
E-Mail: A AM04 Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SllPP EMENT l�GQNSTE� G�TIC?N LIEN LAW INFQRMA IO#�I:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:�� (') S
Address: Address: pn �k
City: State: City: (�ft)-f- l -(�c �t �-`, State:
Zip: Phone Zip: kLAL4g—L Phone: 4 V_ne-�R�rao
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will,in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspprtion. If you intend to obtain financing, consult with lender or an attorney before
commen n work,6r/recording your Notice of Commencement.
Sig ture of Owner/Lessee/Contractor as Ag wrier Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5 �-vc'�Q COUNTY OF
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me
this YN day of 5!!,� 20 NA by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally-Known OR Produced Identification Personally Known OR Produced Identification
Type of Identif' ation Type of Identification
Produced L Cpl._ Produced
(Signature of (Signature of Notary Public-State of Florida)
"'r'vii DEANNA MARIE GIVENS
:. B''0_G-,�
Commission N ° Wp7Y�OMPdISSfON(�GGQ22o23
---ES; 2020 Commission No. (Seal)
°•.',;e��F�o ; BondodThruNotaryPublicUnderwriters
REVIEWS FRONT ZONING• SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED `
DATE
COMPLETED
Rev. 8/2/17